Recurrent Thoracic Outlet Syndrome Following First Rib Resection

Abstract

Five years ago, a follow-up study of first rib resections in patients with the thoracic outlet syndrome (TOS) disclosed a recurrence rate of over 15%. Many patients were re-explored supraclavicularly, and in every case the anterior scalene muscle was found reattached to the bed of the first rib. The invariable success of scalenectomy led to a study of this procedure as the first operation for all cases of persistent thoracic outlet syndrome.

Most patients with TOS gave a history of neck trauma and had symptoms of paresthesias of the hands and weakness of the arms, as well as neck pains and headaches. The common physical findings were tenderness over the scalene muscles and duplication of symptoms with the arms raised. A scalene muscle block with a local anesthetic was the most useful diagnostic test.

The good to excellent long-term results following 239 scalenectomies and 214 first rib resections were almost identical, 68% and 69% respectively, with fair results in 20% and 13% respectively.

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